A group of people connected by at least one common factor are covered by a group health insurance policy instead of an individual’s health insurance. For instance, coworkers at the same company or blood relatives. It provides coverage for multiple individuals. However, the policyholder of an individual health insurance plan is the only person it covers.
Here is a table that compares individual health insurance plans and employee group health insurance:
|Parameter||Group Health Insurance||Individual Health Insurance|
|General Meaning||A group of people are insured under a group health insurance plan.||The holder of an individual health insurance policy is protected.|
|Who is insured?||The insured person, as well as related family members.||Only one person, i.e. the policyholder.|
|How much control does the insured have over the plan?||Limited control (The plan’s coverage and add-ons are under the employer’s or the purchaser’s control).||Complete control (The policyholder fully controls the plan’s add-ons and coverage).|
|Who is the purchaser?||Employers typically purchase group health insurance, or in the case of family floater insurance, the primary family member does so.||The policyholder buys an Individual health insurance plan.|
|Eligibility Criteria:||Must be a permanent employee of an organisation||Needs to have attained at least 18 years of age|
|Option to buy Add-ons:||None or limited||The policyholder can purchase any of the available add-ons.|
|Claims:||Claims are generally made through a third-party administrator.||Claims are made directly with the insurance company.|
|Available Sum Insured:||Very low as compared to Individual Health insurance. It can be anywhere between Rs. 5 to 10 Lakh.||One has the option to select a higher sum insured as compared to a Group health policy. It Can be between Rs. 5 to 15 Lakh.|
|Exit criteria:||When an employee retires or leaves the company, the insurance plan is no longer in effect.||The policyholder turns 65 (the insurance company’s terms determine the exit age).|
|Tax benefit:||No||Yes **|
|Maternity Benefits:||Covered||Need to be purchased under add-ons.|
|Cumulative Bonus:||Not Applicable||Applicable *|
|Medical Check-ups before purchase:||Not required||Required|
|Coverage for Pre-existing diseases:||Mostly from day 1||After the completion of the waiting period.*|
|Coverage for Critical Illness:||No||If chosen by the policyholder*|
Health insurance plans for individuals and groups differ in their benefits of health insurance and objectives. To ensure adequate financial support in times of need, one should always purchase health insurance as needed. According to new regulations, a person may hold multiple health insurance policies. As a result, it is highly recommended that you build a robust health insurance portfolio to reduce any unwanted financial risks in an unexpected medical emergency. A critical illness insurance policy should protect one, an individual plan, and a group health insurance from their employer (if applicable) or a family health insurance plan.*
* Standard T&C Apply
** Tax benefits are subject to change in prevalent tax laws.
Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.